Six questions for better aged care governance

In this guest post, Sarah Barter – principal at Sarah Barter Consulting and convenor with GovernWith, shares some important steps for effective board governance and compliance in aged care businesses.

The Royal Commission into Aged Care Quality and Safety rightly highlighted the importance of governance (both system and provider) in addressing substandard care and improving outcomes for older people in Australia. (i) In response, the Australian Government included “governance” as one of five pillars to support aged care reform. (ii)

But first, what is meant by governance and what are the characteristics of good governance? The UNDP describes good governance as “participatory, transparent and accountable… priorities are based on broad consensus in society and the voices of the poorest and most vulnerable are heard in decision-making”.(iii)

The time is now for providers to consider what this means for you and how to improve governance and effective oversight of the safety and quality of care in practice. Below are six questions Boards and CEOs might like to ask themselves:

  1. Do we have the right skill mix on the Board?

The Royal Commission identified the need for boards and governing bodies to have professional knowledge about the delivery of aged care including clinical expertise. Boards should review and assess its members’ current aged care knowledge and skills; deliver education, particularly on clinical governance; and recruit new members with specialised expertise, if required. 

  • Is the governance structure clear with appropriate Board subcommittees in place?

Boards should ensure a governance structure that provides equal focus on quality and safety of care as well as financial risks and performance. In practice, this means establishing a Quality and Safety Committee (or equivalent) if you don’t already have one and ensuring it has strong Terms of Reference with clear reporting to the Board. The whole Board remains accountable for the delivery of care.

  • How can we include consumers and their representatives in governance and decision-making?

Good governance is participatory. The means involving people in decisions that affect their lives. Ideally, one or two people should be appointed as Consumer Advisors on the Board and be responsible for sharing the views of consumers and the community at the board table. Alternatively, boards may wish to establish a Consumer Advisory Committee or consider other ways to involve consumers in strategic planning sessions.

  • Are we monitoring the right indicators and outcomes?

There are many indicators and systems in use to audit and monitor the quality and safety of care. The question is whether this data is supporting the Executive and board to understand people’s experiences and outcomes and make decisions about how to improve the safety and quality of care. Many indicators are “lag” indicators. Greater attention on lead indicators is required, such as collecting feedback and measuring and reporting health-related quality of life.

  • Is there free flow of information from frontline services up to the Board?

In addition to identifying indicators and systems (e.g. internal audit) for capturing data, organisations must ensure transparency by monitoring and tracking the flow of information from the point of care up to the Board. This requires timely and effective management review to analyse, evaluate and report the information to the Board.

  • Do we know the high priority projects to continuously improve the safety and quality of care?

Investing in systems and processes that enable boards to monitor the safety and quality of care is worthless unless the corresponding action is taken to improve care. The Aged Care Quality and Safety Commission requires aged care providers to maintain a plan for continuous improvement. This plan should be integrated with the organisation’s governance and reporting systems to ensure high priority, organisation-wide projects to improve care are identified, resourced and progressed.

In considering and addressing these questions, Boards and Executives will demonstrate their leadership and commitment to delivering better-aged care. It will also provide evidence to meet the Aged Care Quality Standards, Standard 8 Organisational Governance. (iv)

(i) Royal Commission into Aged Care Quality and Safety 2021, Final Report. Final Report | Royal Commission into Aged Care Quality and Safety

(ii) Australian Government Budget 2021-2022, Governance (Pillar 5 of the Royal Commission response) – Strengthening provider governance. 51 – Governance – Strengthening Provider Governance – Budget 2021-22 fact sheet (

(iii) UNDP 1997, Governance for sustainable human development: a UNDP policy document. Governance for sustainable human development : (

(iv) Aged Care Quality Standards, Standard 8 Organisational Governance. Quality Standards | Aged Care Quality and Safety Commission.


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